Posts tagged ‘healthism’

May 15, 2014

the HAES® files: The Part of the Problem, Problem

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

There is no more neutrality in the world. You either have to be part of the solution, or you’re going to be part of the problem.”

Eldridge Cleaver is credited with saying this in 1968. I have heard myself and others utter some version of this with some frequency lately, so I reckon it’s about time to talk about it in a blog post. Here are some of the contexts in which this “part of the problem” problem has arisen for me lately:

Cultural Switzerland

Readers familiar with my posts know that my writings often originate in the classroom with my health education students. Last week, we were talking about why the idea of cultural neutrality was relatively low on a continuum of cultural competency that we were examining. I could see some confused looks. I found myself walking into the middle of the room and announcing that I was now standing in “cultural Switzerland.”

[What can I say – it was spur of the moment. You can laugh – the students did, too.]

I turned around slowly (the tables were arranged in a “U” – seminar style) and looked each of them in the eye, while saying, “I am going to treat each of you exactly the same when it comes to your health because I don’t notice culture. Your traditions, your values, and your beliefs are all irrelevant because I am neutral.” Then I asked them how that felt, and as you might expect, they didn’t like it all. The ensuing discussion brought out that if you are trying to be “neutral,” then you are actually part of the problem.

Equity vs. Equality

FF1A few days later, a student was struggling with whether to use the word “equality” or “equity” in a paper. She reminded me of this great illustration of kids trying to see over a fence to the baseball game. Equality gives each child the same size box to see over the fence: classic “equal opportunity.” Equity, on the other hand, notices that the children are different heights and gives them each what they need. What was interesting was that many of the sources the student was working with – especially the American sources – were using the word “equality” even when they were really talking about “equity.” I suspect that might be because we distrust equity: we don’t appreciate a collective approach in this culture.

FF2I think it would be difficult to overstate how deeply our cultural love affair with the bootstraps of individual responsibility influences our rhetoric around what is fair and what is right. Could our preference for “equality” actually be part of the problem? Consider the harm done by the notion of “equality” when it comes to – for example – “separate but equal,” or how the idea of “equal opportunity” can serve to mask serious institutional racism and sexism.

The HAES Principles

One of the reasons that we decided we needed to revise ASDAH’s HAES Principles was the realization that ASDAH is a contributor to the larger dialogue about health and that it’s important to take a stand. The original HAES Principles were sound, but incomplete. The HAES community had already begun to grapple in a serious way with issues that were not reflected in the written tenets: issues such as social justice, intersectionality, and healthism. Revising the principles became not just a matter of updating, but also of not being part of the problem.

“Obesity” and Dr. Lustig

At a recent conference I attended, Dr. Robert Lustig was the lunchtime keynote speaker. Dr. Lustig has framed many of his views about nutrition and especially about the dangers of sugar in terms of obesity. Examples include his book Fat Chance and a 2013 YouTube series produced by the University of California on the dangers of sugar entitled “The Skinny on Obesity.” I settled in for what I thought was going to be a fairly frustrating hour. Then, about 10 minutes into his talk, he put up a slide and said emphatically:

If you think obesity is the problem, then you are part of the problem.”

I perked up a bit at that. He went on to explain his view that what we eat – and in particular, the amount of sugar we eat – is what leads to our health problems, not obesity. Of course, he still cited “obesity” as evidence of our ill health – conflating health with weight as almost everyone does. In my book, that makes him still “part of the problem” but maybe a bit less so than I thought…

Obesity Prevention & Treatment

Of course, Dr. Lustig isn’t the only one out there who wants to have it more than one way when it comes to obesity. Many advocate groups, such as the Obesity Action Coalition or the Yale Rudd Center, take positions against weight stigma and discrimination while at the same claiming to fight “obesity.” The OAC appears to have significant ties to the weight loss industry and actively promotes bariatric surgery on their website, so their perspective seems clear. I do wonder who are the 50,000 members that they claim to have, but I’m guessing that many of them make a lot of money from the so-called obesity epidemic. The Rudd Center presents a more complex case. Their funding policy states that they are “committed to transparent, ethical behavior with respect to funding sources” and also that they “will not solicit financial support by the private sector where clear conflicts of interest exist.” And the extensive research, videos, and tool kits that the Rudd Center sponsors in the arena of weight bias and stigma constitute significant contributions to the field.

However, they continue to use an obesity framing for their policy arguments. I do not find these two positions compatible: there can be no Switzerland in the war on obesity. In the words of Desmond Tutu:

If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality.”

Anytime someone frames a policy argument around the idea that a particular weight or body size constitutes a threat to public health, are they not creating the fertile ground for the seeds of bias and stigma? Does that not make them part of the problem?

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